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  • 1.
    Al-Amiry, Bariq
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences. Karolinska Univ Hosp, Dept Radiol, Stockholm, Sweden.
    Mahmood, Sarwar
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Krupic, Ferid
    Sayed-Noor, Arkan
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Leg lengthening and femoral-offset reduction after total hip arthroplasty: where is the problem - stem or cup positioning?2017In: Acta Radiologica, ISSN 0284-1851, E-ISSN 1600-0455, Vol. 58, no 9, p. 1125-1131, article id UNSP 0284185116684676Article in journal (Refereed)
    Abstract [en]

    Background: Restoration of femoral offset (FO) and leg length is an important goal in total hip arthroplasty (THA) as it improves functional outcome. Purpose: To analyze whether the problem of postoperative leg lengthening and FO reduction is related to the femoral stem or acetabular cup positioning or both. Material and Methods: Between September 2010 and April 2013, 172 patients with unilateral primary osteoarthritis treated with THA were included. Postoperative leg-length discrepancy (LLD) and global FO (summation of cup and FO) were measured by two observers using a standardized protocol for evaluation of antero-posterior plain hip radiographs. Patients with postoperative leg lengthening >= 10mm (n = 41) or with reduced global FO >5mm (n = 58) were further studied by comparing the stem and cup length of the operated side with the contralateral side in the lengthening group, and by comparing the stem and cup offset of the operated side with the contralateral side in the FO reduction group. We evaluated also the inter-observer and intra-observer reliability of the radiological measurements. Results: Both observers found that leg lengthening was related to the stem positioning while FO reduction was related to the positioning of both the femoral stem and acetabular cup. Both inter-observer reliability and intra-observer reproducibility were moderate to excellent (intra-class correlation co-efficient, ICC >= 0.69). Conclusion: Post THA leg lengthening was mainly caused by improper femoral stem positioning while global FO reduction resulted from improper positioning of both the femoral stem and the acetabular cup.

  • 2.
    Al-Amiry, Bariq Sh.
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Gaber, John F.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Kadum, Bakir K.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Brismar, Torkel B.
    Sayed-Noor, Arkan S.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    The Influence of Radiological Severity and Symptom Duration of Osteoarthritis on Postoperative Outcome After Total Hip Arthroplasty: A Prospective Cohort Study2018In: The Journal of Arthroplasty, ISSN 0883-5403, E-ISSN 1532-8406, Vol. 33, no 2, p. 436-440Article in journal (Refereed)
    Abstract [en]

    Background: We aimed to investigate the influence of preoperative radiological severity and symptom duration of hip osteoarthritis (OA) on the postoperative functional outcome, quality of life, as well as abductor muscle strength after total hip arthroplasty (THA). Methods: In this prospective cohort study, we studied 250 patients. Preoperatively, we evaluated the function with the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index and quality of life with euroqol-5D (EQ-5D). At 1 year after THA, the same scores and also hip abductor muscle strength were measured in 222 patients. We divided the cohort twice, first according to the radiological OA severity [Kellgren-Lawrence classification (KL)] and then according to the OA symptom duration. We investigated whether the preoperative KL class and symptom duration influenced the 1-year WOMAC (primary outcome measure) or EQ-5D and abductor muscle strength (secondary outcome measures). Results: The crude results showed that KL class and symptom duration had no influence (P = .90 and P = .20, respectively) on the 1-yearWOMAC. Younger age, male gender, and lower body mass index were associated with a better function. Regarding 1-year EQ-5D, the crude results showed that body mass index and KL class had no influence (P = .83 and P = .39, respectively). The adjusted results showed that only age and gender influenced the postoperative EQ-5D. No influence of the tested factors was found on the 1-year abductor muscle strength. Conclusion: Preoperative radiological OA severity and symptom duration had no influence on the outcome of THA and should probably not affect the decision about timing the operative intervention. 

  • 3.
    Mahmood, Sarwar
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Al-Amiry, Bariq
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences. Karolinska University Hospital - Department of Radiology.
    Mukka, Sebastian S
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences. Sundsvall and Norrland University Hospitals.
    Sayed-Noor, Arkan S
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences. Sundsvall and Norrland University Hospitals.
    Leg lengthening and femoral offset reduction after total hip arthroplasty: where is the problem located – stem or cup?Manuscript (preprint) (Other academic)
    Abstract [en]

    Background and aims:

    Restoration of the biomechanical forces around the hip with appropriate femoral offset (FO) and leg length is an important goal in total hip arthroplasty (THA). It is still controversial as to how much postoperative leg length discrepancy (LLD) and FO change are acceptable. The aim of this prospective study is to analyse whether the problem of postoperative leg lengthening and FO reduction is located in the stem or cup or both.

    Material and methods:

    Between September 2010 and April 2013, 174 patients with unilateral primary OA treated with THA were included. Postoperative LLD and global FO were measured using a standardized protocol of the antero-posterior hip radiograph. Patients whose operated leg became ≥ 10mm longer compared with the contralateral side (n=41) or reduction of the global FO > 5mm (n=58) were further studied to investigate the amount of leg lengthening and global FO reduction that took place in the stem and in the cup compared with the contralateral side. We compared the measurements made by an orthopaedic surgeon with the measurements made by a radiologist.

    Results:

    The leg lengthening was located in the stem while the FO reduction was located in both the stem and cup, for the two observers. For observer 1, the mean stem length of the operated side was 57.7 mm vs. 50.9 mm, p=0.003, while the mean cup length of the operated side was 19.0 mm vs. 18.9, p=0.95. For observer 2, the mean stem length of the operated side was 59.5 mm vs. 50.9 mm, p=0.001, while the mean cup length of the operated side was 18.2 mm vs. 18.8, p=0.90. The global FO reduction was located both in the stem and cup for the two observers. For observer 1, the mean stem offset of the operated side was 49.2 mm vs. 57.1 mm, p<0.001, while the mean cup offset of the operated side was 35.1 mm vs. 39.9, p<0.001. For observer 2, the mean stem offset of the operated side was 48.9 mm vs. 55.1mm, p<0.001, while the mean cup offset of the operated side was 35.5mm vs. 40.4mm, p<0.001. Both interobserver reliability and intraobserver reproducibility were substantial to excellent (ICC ≥ 0.79).

    Conclusion:

    Post THA lengthening of the operated leg is mainly caused by improper femoral stem positioning while global FO reduction results from improper positioning of both acetabular and femoral components. Surgeons should be aware of these observations in order to avoid them.

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